Account Holder Information
Email Address*
Company Name
Contact Person Name
Address
Address Cont.
City
State, Zip
Country
Phone
Fax
ICQ
AOL
MSN

Plan*	Setup	Price/month	Server Specification
Account Plan Information
SS1	FREE	$169.95	Intel celeron 2.6 GHz, 1024 MB RAM, 120 GB SATA, 2000 GB, 5 IP's
SS2	FREE	$199.95	Intel P-IV 2.6 GHz, 1024 MB RAM, 120 GB SATA, 2000 GB, 5 IP's
SS3	FREE	$249.95	Intel P-IV 2.6 3.06HT GHz, 1024 MB RAM, 120 GB SATA, 2000 GB, 5 IP's
SS4	FREE	$299.95	Intel XEON 3.06HT Ghz, 1024 MB RAM, 120 GB SATA, 2000 GB, 5 IP's
SS5	FREE	$399.95	Intel DUAL XEON 3.06HT Ghz, 2048 MB RAM RAID/Free 120 GB Backup, 120 GB SATA, 2000 GB, 5 IP's
SS6	FREE	$399.95	DUAL AMD OPTERON 246 2.0 Ghz, 2048 MB RAM RAID/Free 120 GB Backup, 120 GB SATA, 2000 GB, 5 IP's

	Additional Services	Setup	Monthly	Quantity
Additional Features
You already receive some of these features included with your account. This is for additional ones only, and other features upon request. You can also add these features at a later date.
	Extra IP Address Block (8)	$5.00	$5.00
	C Class IP Block (254)	$5.00	$100.00
	Daily Backup Drive (WHM/CPANEL)	$50.00	$10.00	--
	Netscreen 5GT Firewall (10 Users / 10 VPN Tunnels)	$50.00	$105.00	--
	Netscreen 5GT Plus Firewall (Unrestricted Users / 10 VPN Tunnels)	$50.00	$165.00	--
	Netscreen 5GT Extended Firewall ( Unrestricted Users / 25 VPN Tunnels)	$50.00	$300.00	--
	IP-KVM Console Access	$50.00	$75.00	--

DNS Name Servers
If ordering personal DNS name servers above, please supply the name of the name servers you wish to have set up for your usage below: (NS1.YOURNAME.COM, NS2.YOURNAME.COM)
Primary DNS
Secondary DNS

Server Name & Root Password
Please select the name of your server and a password. The password selected should consist of numbers and letters, with mixed upper and lower cases, not based on dictionary words. The server name should be in the format: "name.yourname.com", where "name" can be anything you choose, and "yourname.com" is a domain name you own. (SERVER.YOURNAME.COM)
Server Name
Password

Operating System
Please select the operating system software you wish installed on your server. Cpanel™ / WebHostManager™ will currently only run on Red Hat Linux™.
Operating System*

	Hardware	Setup	Monthly	Quantity
Additional Hardware
	512MB RAM	$50.00	$10.00
	1024MB RAM	$5.00	$100.00
	80DB IDE Hard Drive	$5.00	$100.00

Payment Mode
	Paypal - paypal@severnstream.com
	Credit Card

Comment / Instructions
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